Provider Demographics
NPI:1932302346
Name:JAMWAL, MANDHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDHIR
Middle Name:
Last Name:JAMWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 PROGRESS ST
Mailing Address - Street 2:SUITE D, PO BOX 340
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9384
Mailing Address - Country:US
Mailing Address - Phone:989-345-0945
Mailing Address - Fax:989-345-2831
Practice Address - Street 1:2331 PROGRESS ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-345-0945
Practice Address - Fax:989-345-2831
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine